Factor Structure and Construct Validity of the Pain Resilience Scale Within Chinese Adult Chronic Musculoskeletal Pain Samples

Investigating mortality salience as a potential causal influence and moderator of responses to laboratory pain

Background

Because pain can have profound ramifications for quality of life and daily functioning, understanding nuances in the interplay of psychosocial experiences with pain perception is vital for effective pain management. In separate lines of research, pain resilience and mortality salience have emerged as potentially important psychological correlates of reduced pain severity and increased tolerance of pain. However, to date, there has been a paucity of research examining potentially interactive effects of these factors on pain perception. To address this gap, the present experiment investigated mortality salience as a causal influence on tolerance of laboratory pain and a moderator of associations between pain resilience and pain tolerance within a Chinese sample.

Methods

Participants were healthy young Chinese adults (86 women, 84 men) who first completed a brief initial cold pressor test (CPT) followed by measures of demographics and pain resilience. Subsequently, participants randomly assigned to a mortality salience (MS) condition completed two open-ended essay questions in which they wrote about their death as well as a death anxiety scale while those randomly assigned to a control condition completed analogous tasks about watching television. Finally, all participants engaged in a delay task and a second CPT designed to measure post-manipulation pain tolerance and subjective pain intensity levels.

Results

MS condition cohorts showed greater pain tolerance than controls on the post-manipulation CPT, though pain intensity levels did not differ between groups. Moderator analyses indicated that the relationship between the behavior perseverance facet of pain resilience and pain tolerance was significantly stronger among MS condition participants than controls.

Conclusions

This experiment is the first to document potential causal effects of MS on pain tolerance and Ms as a moderator of the association between self-reported behavior perseverance and behavioral pain tolerance. Findings provide foundations for extensions within clinical pain samples.

Psychometric Properties of Patient-reported Outcome Measures to Assess Resilience in Individuals with Musculoskeletal Pain or Rheumatic Conditions: A COSMIN-based Systematic Review

OBJECTIVES

The objective of this systematic review was to provide a comprehensive overview of the measurement properties of patient-reported outcome measures (PROMs) used to assess resilience in individuals with musculoskeletal and rheumatic conditions.

METHODS

Four electronic databases (MEDLINE, CINAHL, PsycINFO, and Web of Science) were searched. Studies assessing any measurement property in the target populations were included. Two reviewers independently screened all studies and assessed the risk of bias using the COSMIN checklist. Thereafter, each measurement property of each PROM was classified as sufficient, insufficient, or inconsistent based on the COSMIN criteria for good measurement properties.

RESULTS

Four families of PROMs [Brief Resilient Coping Scale (BRCS); Resilience Scale (RS-18); Connor-Davidson Resilience Scale (CD-RISC-10 and CD-RISC-2); and Pain Resilience Scale (PRS-14 and PRS-12)] were identified from the 9 included studies. Even if no PROM showed sufficient evidence for all measurement properties, the PRS and CD-RISC had the most properties evaluated and showed the best measurement properties, although responsiveness still needs to be assessed for both PROMs. Both PROMs showed good levels of reliability (intraclass coefficient correlation 0.61 to 0.8) and good internal consistency (Cronbach's alpha ≥0.70). Minimal detectable change values were 24.5% for PRS and between 4.7% and 29.8% for CD-RISC.

DISCUSSION

Although BRCS, RS-18, CD-RISC, and PRS have been used to evaluate resilience in individuals with musculoskeletal and rheumatic conditions, the current evidence only supports the use of PRS and CD-RISC in this population. Further methodological studies are therefore needed and should prioritize the assessment of reliability and responsiveness.

Promising Subjective and Objective Benefits of Modified Mindfulness-Based Stress Reduction Training for Chinese Adults with Chronic Pain: A Pilot Randomized Control Study

INTRODUCTION

Mindfulness-based stress reduction (MBSR) has demonstrated its effectiveness in reducing pain-related stress in adults with chronic pain. However, the implementation of MBSR needs modifications across cultures. This pilot study reports the findings of a randomized controlled trial that investigated the effects of a culturally adaptive MBSR program on self-report and neuroimaging outcomes for chronic pain adults in China.

METHODS

Sixty-seven participants were randomly assigned to the treatment group (n = 40) or the treatment-as-usual group (n = 27) group at a ratio of 1.5:1. Participants completed self-report measures of pain severity, pain interference, depression, perceived stress, pain catastrophizing, mindfulness, and resilience at baseline assessment (T1), post-treatment (T2), and 3-month follow-up (T3) assessments. Functional magnetic resonance imaging (fMRI) scanning was also performed at T1 and T3 assessments.

RESULTS

For the intention-to-treat sample, the results of the mixed-effect model indicated that Group × Time interaction was significant for pain catastrophizing only (F (2, 130) = 3.51, p = 0.033). Compared with the control group, those in the MBSR group reported greater reductions in pain catastrophizing at T2 (d = - 0.60), though this effect was not maintained at T3 (d = - 0.05). Additionally, the results of completer analyses found significant Group × Time interactions for pain interference (F (2, 88) = 4.40, p = 0.015) and perceived stress (F (2, 88) = 3.13, p = 0.048), but not for other measures. Finally, both groups exhibited decreased regional homogeneity (ReHo) in the frontal lobe, while increased ReHo in the cerebellum anterior lobe was unique to the MBSR group.

CONCLUSIONS

The present findings suggest that the minor modified MBSR program improves certain pain-related outcomes for Chinese adults with chronic pain. Future studies with larger samples of Chinese chronic pain patients are needed to detect the small-to-moderate benefit of MBSR on fMRI and/or other objective methods.

Cross-Cultural Adaptation and Psychometric Validation of the Turkish Version of Pain Resilience Scale

The Pain Resilience Scale (PRS) is a useful tool that evaluates behavioral engagement and adaptively regulates cognitions and emotions despite the pain. This study aimed to translate the PRS to Turkish and investigate its psychometric properties. The Turkish version of PRS was completed online by 332 healthy adults, and a subset of 105 respondents was re-assessed after 7-14 days. The reliability of the adapted measure was evaluated in terms of internal consistency, relative, and absolute test-retest reliability. Validity was evaluated in terms of structural, construct, and known-group validity using positive and negative psychological scales. The Turkish version of PRS has a three-factor structure and its cumulative variance is 78.06%. The total PRS score and its subscales correlated positively with pain self-efficacy, general resilience, and quality of life, and negatively with pain catastrophizing, kinesiophobia, anxiety, depression, and disability. The PRS scores were significantly higher in those with high general resilience (p < 0.001). The PRS had high internal consistency and test-retest reliability. Standard Error of Measurement (SEM) and Minimum Detectable Difference (MDD) were calculated as 2.9 and 8.0, respectively. The Turkish version of PRS is a reliable and valid instrument for measuring pain resilience in terms of behavioral perseverance and cognitive positivity.

EXPRESS: Testing links between pain-related biases in visual attention and recognition memory: An eye-tracking study based on an impending pain paradigm

Although separate lines of research have evaluated pain-related biases in attention or memory, laboratory studies examining links between attention and memory for pain-related information have received little consideration. In this eye-tracking experiment, we assessed relations between pain-related attention biases (ABs) and recognition memory biases (MBs) among 122 pain-free adults randomly assigned to impending pain (n = 59) versus impending touch (n = 63) conditions wherein offsets of trials that included pain images were followed by subsequent possibly painful and non-painful somatosensory stimulation, respectively. Gaze biases of participants were assessed during presentations of pain-neutral (P-N) and happy-neutral (H-N) face image pairs within these conditions. Subsequently, condition differences in recognition accuracy for previously-viewed versus novel pained and happy face images were examined. Overall gaze durations were significantly longer for pain (versus neutral) faces that signaled impending pain than impending non-painful touch, particularly among the less resilient in the former condition. Impending pain cohorts also exhibited comparatively better recognition accuracy for both pained and happy face images. Finally, longer gaze durations on pain faces that signaled potential pain, but not potential touch, were related to more accurate recognition of previously-viewed pain faces. In sum, pain cues that signal potential personal discomfort maintain visual attention more fully and are subsequently recognized more accuracy than are pain cues that signal non-painful touch stimulation.

Identifying resting state differences salient for resilience to chronic pain based on machine learning multivariate pattern analysis

Studies have documented behavior differences between more versus less resilient adults with chronic pain (CP), but the presence and nature of underlying neurophysiological differences have received scant attention. In this study, we attempted to identify regions of interest (ROIs) in which resting state (Rs) brain activity discriminated more from less resilient CP subgroups based on multiple kernel learning (MKL). More and less resilient community-dwellers with chronic musculoskeletal pain (70 women, 39 men) engaged in structural and functional magnetic resonance imaging (MRI) scans, wherein MKL assessed Rs activity based on amplitude of low frequency fluctuations (ALFF), fractional amplitudes of low frequency fluctuations (fALFF), and regional homogeneity (ReHo) modalities to identify ROIs most salient for discriminating more versus less resilient subgroups. Compared to classification based on single modalities, multi-modal classification based on combined fALFF and ReHo features achieved a substantially higher classification accuracy rate (79%). Brain regions with the best discriminative power included those implicated in pain processing, reward, executive function, goal-directed action, emotion regulation and resilience to mood disorders though variation trends were not consistent between more and less resilient subgroups. Results revealed patterns of Rs activity that serve as possible biomarkers for resilience to chronic musculoskeletal pain.

Cross-Cultural Adaptation and Validation of the Physical Disability Resiliency Scale in a Sample of Chinese With Physical Disability

This study adapted the Physical Disability Resilience Scale (PDRS) to Chinese conditions and evaluated the psychometric characteristics of the Chinese version in individuals with physical disability. A total of 438 individuals with physical disability were included in this study. The PDRS was translated to Chinese using a backward translation method. Construct validity, internal consistency reliability, and convergent validity were examined. Confirmatory factor analysis failed to replicate the original five-factor structure of the PDRS. After removing the Spirituality factor and an underperformed item (Item 22), exploratory factor analysis yielded four trait factors (i.e., Emotional and Cognitive Strategies, Physical Activity and Diet, Peer Support, and Support from Family and Friends) and a method-effect factor. A correlated trait-correlated method model that included the four trait factors and a method-effect factor reported better model fit than the four-factor model, which did not consider method effects. The four subscales of the revised PDRS showed adequate internal consistency. The convergent validity of the revised PDRS was established by the moderate-to-strong associations between its four subscales and theoretically related constructs. We conclude that the revised PDRS is a reliable and valid measure in assessing resilience among Chinese people with physical disability.